Objective: The thumb is very exposed to trauma due to its position and function. Fractures of the base of the first metacarpal bone are very frequent in hand traumatology. Most Bennett’s fractures are treated surgically. However, the optimal surgical approach is controversial. The aim of this study is to compare the results of closed reduction and percutaneous pinning in the treatment of Bennett’s fracture of the base of firsthand metacarpal in fractures with both small and large fragments. Methods: We studied retrospectively the data of 40 patients treated for a Bennett’s fracture in the department of orthopaedic and traumatologic surgery between January 2016 and December 2018. The purpose of this study was to compare the functional (pain, grip strength, first web space opening and thumb opposition) and radiological (quality of reduction and arthritic changes) results of the Iselin’s technique for the treatment of Bennett’s fractures in two groups of patients with large and small bone fragments according to the size of articular surface detached with the antero-medial fragment (superior or inferior to 25%). Results: The average age of the patients was 34 (range = 19–66) years. Males were by far the most affected (90%). We noted 24 cases of large fragment fractures (60%) and 16 cases of small fragment fracture (40%). An excellent overall functional result was found in 68.8% of cases of small fragment fractures versus 50% of cases of large fragment fractures. Radiological results were roughly similar. Conclusion: All surgical techniques aim to restore the articular congruence to the best, maintain the opening of the first web space and obtain a stable and painless trapezo-metacarpal joint. The Iselin’s technique is simple, inexpensive and easy to perform even by inexperienced surgeons. It yields satisfactory results in most cases of Bennett’s fracture regardless of the size of the fragment.
Atypical fibroxanthoma is a rare fibrohistiocytic tumour with intermediate malignancy that generally affects photoexposed areas of the elderly. The diagnosis is anatomopathological and the management is surgical. We report the case of a spontaneous regression of an atypical fibroxanthoma of the hand. This phenomenon is a very rare situation related to a probable immunological response.
Introduction: Tumors of the spleen are rare in children, but they present a wide range of diagnostic, histological and radiological appearance. Splenic cysts are far more common than solid lesions. Cysts may be congenital (epidermoid cysts), infectious (abscess or hydatid cyst), or neoplastic (lymphangioma or angioma with tumor necrosis). They are most often asymptomatic. Diagnosis can usually be established with the clinical context and radiology (ultrasound, CT, MRI). Different options for the management of splenic cysts are available to the pediatric surgeon, ranging from simple monitoring to surgical excision. Minimally invasive surgical techniques and spleen conservative surgery have made splenic surgery less aggressive. The aim of the study was to describe the clinical and paraclinical characteristics of splenic cysts in children, and to assess their management. Patients and Methods: In a retrospective study within the pediatric surgery department in tunis, Tunisia, we have collected five children with a diagnosis of splenic cyst during the last decade. We specified for each patient the functional signs and physical examination data, ultrasound and CT were done for the patients, specifying the location and the size of the cysts. Hydatic serology was done when the parasitological origin was suggested. After surgical management and histological confirmation, the follow–up was based on clinical examination and abdominal ultrasound. Results: They were three girls and two boys. The average age is ten and a half years. All patients were symptomatic with abdominal pain. The size of the cysts was significantly increased in all patients with an average of 11 cm. Surgery was indicated for all cases. Three patients had cystic resection and two had partial splenectomy. The histology objectified epithelial cyst for three patients and hydatid cyst of the spleen for the other two cases. The subsequent outcome was favorable for all patients with a current mean follow-up of three years. Conclusion: Splenic cysts are rare in children and their management is still controversial. In splenic cysts, imaging can give clues to the diagnosis, but it often requires pathological examination of the part. Resection should be as limited as possible in order to avoid the risk of total splenectomy.
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